The Roanoke Valley Community Healthy Living Index
Fairview Elementary School Health Report 2017 Health Status and Perceived Access to Healthy Living Resources
Acknowledgement: The Roanoke Valley Community Healthy Living Index is directed by Dr. Liz Ackley, Associate Professor at Roanoke College, and is graciously supported through the Brian H. Thornhill Endowed Professorship (Roanoke College) and the Roanoke City Invest Health Initiative (Robert Wood Johnson Foundation and Reinvestment Fund). The Roanoke Valley Community Healthy Living Index is made possible through the support of the Roanoke City Public School System, who has served as an active partner since 2011. The 2017 Health Reports for the Roanoke Valley Community Healthy Living Index were prepared by Dr. Liz Ackley with the attentive assistance of Hailey Sitze, Hannah Kolcz, Emily Hutchinson, and Marissa Freeman (Undergraduate Research Assistants, Roanoke College), and Brittney Cerebe (Research Fellow, Hidden Valley High School). For more information or for questions concerning this report, please contact Dr. Liz Ackley at
[email protected].
Disclaimer: The Roanoke Valley Community Healthy Living Index (RV-CHLI) was developed to propagate positive change toward the elimination of health disparities in Roanoke, Virginia. This report is intended for use by the community and can be cited accordingly: Ackley, E., Hutchinson, E. & Kolcz, H. (2017). The Roanoke Valley Community Healthy Living Index: 2017 Fairview Elementary School Health Report. As a means to encourage the long-term sustainability of the RV-CHLI, users are asked to contact the director at
[email protected] when reports are used to support organizational or community efforts. While an internal committee has reviewed the data presented in this report, complete accuracy cannot be guaranteed. The authors assume no liability for the use or misuse of this data. 2
Table of Contents Background…………………………………………………………………………………………………… 5 Executive Summary………………………………………………………………………………………….. 6 Figure 1: Prevalence of weight status among Roanoke City elementary school-aged youth………………………………………………………………………………….. 6 Figure 2: Weight status of Roanoke City public elementary school students by grade level……………………………………………………………………………………….. 6 2017 Fairview Elementary School Assessment Results...………………………………..………….….. 7 I. Youth Health Status ………………………………………………………………………….……. 7 (a) Weight-Related Health Status…..………….…………..…………………………….. 7 Table 1: Youth weight status…………………………………………..………… 7 (b) Cardiovascular Health Status………………………………..………………………. 8 Table 2: Cardiovascular health status of youth……….…………..…………… 8 II. Healthy Behaviors………………………………………………………….………………..…… 9 (a) Physical Activity………………………………………………….……………..……... 9 Figure 3: Neighborhood physical activities……..………………..……… 9 Figure 4: Neighborhood safe routes……………………………………… 10 Figure 5: Active commuting………………………………………..……… 10 Figure 6: Barriers to physical activity…………………………….……… 10 i. Perceived Access to Resources Supporting Physical Activity……...…… 10 Figure 7: Resources supporting physical activity………………..… 10 Figure 8: Safety of resources……………………………………..…… 10 ii. Perceived Safety for Engaging in Physical Activity……………………… 10 Figure 9: Perceived traffic in areas supporting physical activity………………………………………………………………….... 10 Figure 10: Perceived police presence in areas supporting physical activity………………………………………………………… 11 Figure 11: Perceived daytime safety………………………………... 11 Figure 12: Perceived evening safety………………………………... 11 iii. Recommendations for Promoting Neighborhood-Level Physical Activity………………………………………………………………………… 12 Figure 13: Recommendations for enhancing neighborhood physical activity………………………………………………………… 12 3
(b) Healthy Eating…………………….…..…………………………………………….... 12 i. Perceived Neighborhood-Level Access to Healthy Foods ……………… 12 Figure 14: Perceived Access to Healthy Foods…………………….. 12 Figure 15: Incentives for Healthy Foods…………………………….. 12 III. Healthy Living………………………………………………………………………………….. 13 i. Neighborhood Culture of Healthy Living………………………………….. 13 Figure 16: Neighborhood culture of physical activity…………….. 13 Figure 17: Neighborhood culture of healthy eating……………….. 13 Figure 18: Neighborhood support for promoting a culture of health…………………………………………………………………….. 13 Figure 19: Neighborhood engagement in enhancing a culture of health…………………………………………………………………. 13 IV. Actionable Recommendations………………………………………………………………. 14
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Background: The Roanoke Valley Community Health Living Index (RV-CHLI) was developed in 2011 to facilitate awareness of relationships between “place” and health across Roanoke’s city neighborhoods. Adapted from a previously validated tool developed by the Centers for Disease Control and Prevention1, the RV-CHLI combines GIS technologies with familial perceptions of access to healthy living resources and objective measures of youth health outcomes 2 . In this way, the RV-CHLI serves to empower community stakeholders to make informed decisions in the development of projects and programs seeking to improve community health while encouraging cross-sector partnerships as a means to enhance collective impact in the neighborhoods that need it most. In addition to providing an array of local stakeholders with benchmark data concerning youth health status across the city of Roanoke, the RV-CHLI has served as a catalyst for strategic planning for the Roanoke City Invest Health Initiative and the PATH Coalition.
Soowon, K., et al. (2009). Development of the Community Healthy Living Index: A tool to foster healthy environments for the prevention of obesity and chronic disease. Preventive Medicine, 50(S), 80-85. 1
Youth health outcomes used in this assessment were determined objectively from the FitnessGram Test Battery. More information on this widely-accepted assessment can be found at http://www.cooperinstitute.org/fitnessgram/components. 2
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Executive Summary: Across the city of Roanoke, considerable variation exists relative to the prevalence of healthy weight status in youth (see Figure 1). When compared to national prevalence rates, Roanoke elementary school-aged youth display higher rates of underweight and obesity and lower rates of healthy weight and overweight versus similarly-aged youth3. Whereas 38% of elementary schoolaged youth across the United States experience health risk due to suboptimal weight status3, 48% of Roanoke City elementary school-aged youth classify as at risk4. Figure 1. Prevalence of weight status among Roanoke City elementary school-aged youth
Note: Figure stratified by school attendance zone.
In 2017, health outcomes data (derived from the FitnessGramt test battery) were not provided by Fairview Elementary School staff. Therefore while grade-level trends in weight status across Roanoke indicate a gradual increase in overweight and obesity from kindergarten to 5th grade (Figure 2), trends among youth attending Fairview Elementary are unknown. In reflecting on neighborhood-level access to healthy living resources which may impact healthy behaviors, among Fairview Elementary families:
Figure 2. Weight status of Roanoke City public elementary school students by grade level 60% 40% 20% 0% K
1st Underweight Overweight
2nd
3rd
4th
5th
Healthy weight Obese
55% perceive they have adequate access to spaces supporting physical activity. 72% perceive they have sufficient access to healthy foods. 51% perceive their neighborhood is safe for engaging in daytime physical activities, compared to 53% in the evening. Families consider sidewalk access and proximity to parks as the leading infrastructure needs for promoting healthy living their neighborhood. 53% perceive their neighbors are engaged in creating a culture of health in their neighborhood.
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The National Center for Health Statistics report can be found at https://www.cdc.gov/nchs/data/hestat/obesity_child_13_14/obesity_child_13_14.pdf 4 As indicated by combined prevalence rates of underweight, overweight, and obesity.
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2017 Fairview Elementary School Assessment Results Youth Health Status Weight-Related Health Status: The measurement of body mass index-for-age (BMI-for-age) allows for the assessment of weightrelated health risk in youth while controlling for maturation as children age. Derived from assessments of weight and height, BMI-for-age percentiles can be used to classify a child as underweight (< 5th percentile for age), healthy weight (> 5th to < 85th percentile for age), overweight (< 85th to < 95th percentile for age), or obese (> 95th percentile for age)5. BMI-for-age is determined as a part of the FitnessGram test battery, an annual assessment of the components of health-related fitness conducted by school physical educators. Recent data reported by the National Center for Health Statistics (2015) indicates that, when viewing BMI-for-age percentiles at the national level, 17.5% of school-aged children (6-11 years) are obese, whereas 17.2% of children classify as overweight 3. When underweight status is considered (comprising 3.5% of the youth population), roughly 38% of youth are classified as having increased health risk due to unhealthy weight3. In line with national trends, state-level indicators suggest that approximately 31% of youth in the Commonwealth are overweight or obese 6 . Results from the 2017 assessment of BMI-for-age across Roanoke Table 1; data from Fairview Elementary was not submitted. Table 1: Youth weight status
BMI-for age Classification
Fairview Elementary
Boys --
Girls --
Total ---
Healthy Weight
--
--
Overweight
--
Obese
Underweight
Total number of students (n)
Roanoke City
United States
7%
4%
--
52%
63%
--
--
16%
17%
--
--
--
25%
17%
0
0
0
5,372
n/a
Note. FitnessGram data was not submitted by Fairview Elementary; the Roanoke City sample represents 73% of students enrolled in Roanoke City public elementary schools.
National statistics indicate that approximately 4% of children classify as underweight and 63% display a healthy weight for age and height, while 17% of children are overweight and 17% are obese. When viewed collectively, 38% of youth nationally display a compromised health profile For more information on BMI-for-age, including measurement and interpretation guidelines, visit https://www.cdc.gov/obesity/childhood/defining.html 6 http://childhealthdata.org/docs/nsch-docs/virginia-pdf.pdf?sfvrsn=0 5
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due to unhealthy weight. Moreover, when examining sex-related trends in overweight and obesity, national trends in school-aged children (6-11 years) indicate that approximately 16% of boys and girls are overweight and approximately 17% of boys and girls are obese4. It is unknown how youth at Fairview Elementary School compare to these statistics. Since BMI-for-age percentiles control for maturation as children age, healthy weight status should be maintained over time. When considering age-related trends in weight status at a national level, the prevalence of obesity gradually increases with age, from 9% among youth aged 2-5 years, to 17% among youth aged 6-11 years, to 21% among adolescents aged 12-19 years3. Across Roanoke, elementary school-aged youth experience a similar trend (see Figure 2, pg. 6), with rates of overweight and obesity increasing from kindergarten to fifth grade. At Fairview Elementary School, age-related trends in youth weight status are unknown.
Cardiovascular Health Status: Cardiovascular health status can be inferred from the PACER test of the FitnessGram test battery, which results in the prediction of VO2max (a cardiovascular fitness indicator) from a continuous running test. Using a controlled running distance (15 or 20 meters) and running speeds that gradually increase in controlled increments, the number of laps a child completes can be used to assess a child’s age-related cardiovascular fitness status. From this assessment, children are scored relative to a “healthy”, “some risk”, or “high risk” fitness zone7. At the elementary-school level, the PACER test is generally conducted among 4 th and 5th grade student only. For this reason, limited data exists to illustrate the current status of cardiovascular fitness in elementary school-aged youth across the United States. In light of this limitation, data from the National Youth Fitness Survey indicates that 43.6% of youth aged 12-13 years display adequate cardiovascular fitness, with higher prevalence rates reported in boys (51.2%) than girls (35.7%) 8 . Data from the 2017 PACER assessment at Fairview Elementary School were not provided; data from Roanoke city schools are reported in Table 2. Table 2: Cardiovascular health status of youth
Cardiovascular Fitness Classification Healthy
Fairview Boys --
Girls --
--
Roanoke City 89%
Total
Some Risk
--
--
--
10%
High Risk
--
--
--
1%
--
--
--
Total (n)
583
Note: Given the small sample (which is derived from 4th and 5th grade students only) this data should be interpreted with caution.
For more information about the PACER assessment, visit http://www.cooperinstitute.org/fitnessgram/aerobic-capacity. While limited national data exists concerning the cardiovascular fitness status of youth, the National Youth Fitness Survey provides recent insight: https://www.cdc.gov/nchs/products/databriefs/db153.htm. 7 8
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Healthy Behaviors An individual’s health status is influenced by a number determinants, including (but not limited to) family education attainment, income and employment, genetics, the physical environment, safety, social support, access to clinical and wellness services, and engagement in healthy behaviors. Not surprisingly, as much as 20-50% of the variation in health status between individuals can be explained by healthy behaviors9, yet the ability to engage in healthy behaviors is largely influenced by access to healthy living resources, such as supportive infrastructure and services. To evaluate engagement in healthy behaviors and access to healthy living resources, families were asked to describe their child’s physical activity and healthy eating behaviors and to rate their perceived access to resources supporting healthy living in their neighborhood. Due to the voluntary nature of the survey, attention should be given to the sample size before generalizing this data. In 2017, 51 families from Fairview Elementary School volunteered to complete the Neighborhood Physical Activity Assessment, representing 9% of enrolled students.
Physical Activity Participating students (with the help of their parents/guardians) were asked to describe the types of physical activities they engage in at home or in their neighborhood. Among Fairview Elementary School students, the most commonly reported activities included biking (20% of respondents), playing in the neighborhood (18%), and walking (17%); see Figure 3.
Figure 3. Neighborhood physical activities
While families generally agreed that a “Safe Routes to School” or walking school bus program existed in their home neighborhood (Figure 4), only 12% of students reported walking or riding their bike to school [Figure 5; this is comparable to reports of active commuting citywide (12%)]. Among those students, kindergarten students were most likely to actively commute. Figure 4. Neighborhood safe routes The neighborhood has a "Safe Routes to School" or "walking school bus" program
40% 30% 20% 10% 0%
"Do you walk or ride your bike to school?" Yes
12%
Strongly Agree Agree
Neutral Disagree Strongly Disagree
Females
Figure 5. Active commuting No
19% 81%
Males
88% 100%
Infographic developed by the Bipartison Policy Center: https://bipartisanpolicy.org/library/what-makes-us-healthy-vs-what-we-spend-onbeing-healthy/. 9
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When asked to identify barriers to engaging in physical activities, the most commonly reported barriers related to poor park equipment or proximity to parks (33% of responses), lack of sidewalks (17% of responses), and general neighborhood safety concerns (11% of responses); see Figure 6.
Figure 6. Barriers to physical activity
Perceived Access to Resources Supporting Physical Activity In order to understand neighborhood-level resources for engaging in physical activities, students (with the help of their parents/guardians) were asked to rank their perceived level of access to infrastructure supporting physical activity. Among Fairview Elementary families, 55% of students believe they have sufficient access to parks and recreational facilities supporting physical activity (see Figure 7); this is a lower level of access than what is perceived by families citywide (74%). When asked to consider safety issues concerning these resources, 30% of respondents perceived their neighborhood parks, sidewalks, and parking areas were sufficiently lit to be considered safe (compare to 40% citywide; Figure 8). Figure 7: Resources supporting physical activity "Parks and other areas are available for people of all ages to be active in the neighborhood" Strongly Agree
16% 31%
Agree
12% 17%
Figure 8. Safety of resources "Sidewalks, parks, and parking spots in the neighborhood are well lit at night to keep us safe"
22%
Agree
18%
Neutral Disagree
24%
Strongly Agree
12%
Strongly Disagree
Neutral Disagree
20%
Strongly Disagree
28%
Perceived Safety for Engaging in Neighborhood-Level Physical Activity Because safety is a significant determinant of physical activity in youth, families were prompted to provide more detail regarding safety-related factors in their neighborhood. According to 43% of families at Fairview Elementary School, heavy traffic and inappropriate driving speeds are perceived as significant dangers in the neighborhood (Figure 9); this is lower than city-wide perceptions of traffic (wherein 57% of Roanoke City families disagree or strongly disagree that drivers obey speed limits and yield to pedestrians). Figure 9: Perceived traffic safety in areas supporting physical activity "Car drivers obey speed limits in the neighborhood and stop for people crossing the street" 16% 29%
Strongly Agree Agree
16%
Neutral Disagree
14% 25%
Strongly Disagree
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When prompted to describe police presence in areas supporting physical activity, families of Fairview Elementary School perceived the visibility of police officers in their neighborhood could be improved, with 64% of families reporting “neutral” to “strongly agree” (see Figure 10). This response is slightly lower than what was perceived by families across Roanoke, wherein 69% of families report adequate levels of police presence in areas supporting physical activity10. Figure 10: Perceived police presence in areas supporting physical activity "Police officers watch neighborhood areas used for physical activity to keep us safe" 35% 30% 25% 20% 15%
10% 5% 0% Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall, 51% of Fairview Elementary School families perceive the neighborhood is safe for supporting daytime physical activity for elementary school-aged youth11 (compared to 58% citywide); see Figure 11. Moreover, 53% of families perceive the neighborhood is safe for supporting physical activity in the evening11 (Figure 12; with 25% of families reporting “neutral”), compared to 44% of families citywide. Figure 11. Perceived daytime safety "People who walk and bike in the neighborhood during the day feel safe" 4% 12%
18%
Figure 12. Perceived evening safety "People who walk or bike in the neighborhood in the evening feel safe" 10%
Strongly Agree
Agree
16%
12%
Agree
Neutral
Neutral
Disagree 33%
33%
Strongly Disagree
Strongly Agree
Disagree 25%
37%
Strongly Disagree
As indicated by a “neutral”, “agree”, or “strongly agree” response to the prompt “Police officers watch areas used for physical activity, like parks and playgrounds, to keep us safe”. 11 As indicated by a “strongly agree” or “agree” response to the prompts, “People who walk and bike in the neighborhood during the day feel safe” or “People who walk and bike in the neighborhood in the evening feel safe”. 10
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Recommendations for Promoting Neighborhood-Level Physical Activity To enhance particiation in neighborhood-level physical activities, families of Fairview Elementary suggest that attention should be given to enhancing sidewalk availability (27% of responses) and improving safety (20% of responses; namely in existing parks and residential areas). Residents also indicated a need for adding closer parks (18%) and updating existing parks (14%); see Figure 13.
Figure 13: Recommendations for enhancing neighborhood physical activity
Healthy Eating Perceived Neighborhood-Level Access to Healthy Foods Participating students (with the help of their parents/guardians) were asked to describe the level of accessibility to healthy foods in their home neighborhood. Compared to 69% of families citywide, 72% of Fairview Elementary families perceive they have easy access to stores offering healthy foods in their neighborhood12 (Figure 14). When asked if incentives were provided by neighborhood stores to encourage health eating, 56% of Fairview Elementary School families agreed13, compared to 38% of families citywide (Figure 15). Figure 14: Perceived access to healthy foods "Food stores offering healthy foods are in walking distance from home or are easy to get to by bus"
10%
6%
"Neighborhood food stores give us coupons or lower prices for healthy foods and drinks" 6%
Strongly Agree 37%
12%
Figure 15: Incentives for healthy foods
Agree
20%
23%
Agree
Neutral Disagree 35%
Strongly Disagree
Strongly Agree Neutral
18%
33%
Disagree Strongly Disagree
As indicated by responding “agree” or “strongly agree” to the statement, “Food stores offering healthy foods are in walking distance or are easy to get to by bus”. 13 As indicated by responding “agree” or “strongly agree”. 12
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Healthy Living Neighborhood Culture of Healthy Living To better understand the culture supporting healthy living in Fairview Elementary neighborhoods, participating students (with the help of their parents/guardians) were asked to describe their interactions with neighbors relative to healthy living behaviors (namely physical activity and healthy eating). Among Fairview Elementary families, 37% of families report spending time with neighbors while engaging in physical activities (compared to 39% of families citywide); see Figure 16. Moreover, 28% of families report that healthy foods are served when neighbors gather to spend time together, compared to 30% citywide (Figure 17). Figure 16: Neighborhood culture of physical activity
Figure 17: Neighborhood culture of healthy eating
"Neighbors spend time together being physically active (walking, jogging, playing sports)"
"When neighbors get together, healthy foods are served"
10%
14%
12%
Strongly Agree
12%
Strongly Agree
Agree 18%
27%
Neutral
16%
20%
Disagree
Agree
Neutral Disagree
Strongly Disagree
Strongly Disagree 40%
31%
Reflecting the low level of neighborhood engagement in healthy behaviors reported by Fairview Elementary families, only 20% of families in Fairview Elementary School neighborhoods feel they have a group of individuals in the neighborhood who are enhancing their neighborhood culture of health (Figure 18). This rate is considerably lower than what is reported citywide (37%). When prompted to report if neighbors had been active in promoting a culture of health in their neighborhood, 16% of families agreed or strongly agreed (compared to 28% citywide; Figure 19). Figure 18: Neighborhood support for promoting a culture of health "We have a group of people in the neighborhood who can help make our neighborhood more healthy" Strongly Agree
12% 6% 14%
Agree
Figure 19: Neighborhood engagement in enhancing a culture of health "In the past year, people in our neighborhood have done something to make the neighborhood more healthy or safe" 0% 22%
16%
Agree
Neutral
23%
Neutral
Disagree Strongly Disagree 45%
Strongly Agree
25%
37%
Disagree Strongly Disagree
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Actionable Recommendations
GET INVOLVED! The Roanoke Valley Community Healthy Living Index was developed to support actionable planning across Roanoke’s diverse neighborhoods. There are numerous ways to get involved to make our neighborhoods healthier. Consider becoming involved with one or more of the following groups or organizations listed on this page.
JOIN YOUR NEIGHBORHOOD FORUM All of Roanoke’s historic neighborhoods are supported by a neighborhood group. These groups are served by residents who are working to realize their vision for a thriving community. Visit http://www.roanokeva.gov/1198/Linksto-Neighborhoods to learn more.
ADVOCATE
SHARE YOUR IDEAS
Policies encouraging healthy living, including healthy eating and physical activity, need support from community members like you! Contact your local elected officials and community leaders to advocate for health in all policies, or serve on a local advisory commission (vacancies on local commissions can be found here: http://www.roanokeva.gov/1066/Vacan cies).
The Roanoke Valley Community Healthy Living Index supports the work of Invest Health, an initiative aimed at enhancing equitable access to healthy living resources across Roanoke city neighborhoods. If you have an idea, contact the Invest Health team at
[email protected].
* This page was adapted from The Health Collaborative’s “Executive Summary: What Can You Do?”, found at www.thehealthcollab.com
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